• Pref. Drug List
• Prior Authorization
• Specialty Meds
• Ways to Save...
• File a Claim
• Mail Order
• Medicare D
• Rx Programs

• Drugs Requiring Prior Approval
• Drugs Requiring Step Therapy
• Drugs Subject to Quantity Limits
• PA Appeals Process

Some prescription drugs may require prior authorization, step therapy and/ or be subject to quantity limits.   It is very important to make sure that prior approval is received before going to a pharmacy to fill your prescription.  Please note:  Some drugs may be subject to both prior authorization or step therapy and quantity limits.

To initiate a prior authorization request of your prescription drugs, your physician may call Medco at 1-800-753-2851, or fax in a prior review form directly to Medco at the number listed on the form. 

If a medication may also be covered under the medical benefit and the drug will be given in the medical office, physicians should contact Blue Cross and Blue Shield of NC for approval (These medications are marked with an asterisk *). 

The State Health Plan may change the list of prescription drugs that require prior approval, step therapy and/or be subject to quantity limits.

If you disagree with a decision made during the prescription drug prior authorization process, you have the right to request that the State Health Plan or its representative review the decision through the grievance process. The grievance process is voluntary and may be requested by the member or an authorized representative acting on the member's behalf. Visit the PPO plan grievance page.